Orbital involvement in sickle cell disease: A report of five cases and review literature

Anuradha Ganesh, Ranjan R. William, Sandip Mitra, Sujatha Yanamadala, Samir S. Hussein, Salam Al-Kindi, Mathew Zakariah, Zakia Al-Lamki, Huxley Knox-Macaulay

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Abstract

Purpose. To present five cases of orbital infarction in sickle cell disease and review relevant literature. Method. We reviewed the hospital records of 5 patients with sickle cell disease who developed a periorbital swelling during a vaso-occlusive crisis and were managed at our hospital between April 1992 and June 2000. Results. The 5 patients (4 with homozygous sickle cell disease and 1 with sickle cell-β-thalassaemia disease) were aged 6-15 years with a history of multiple admissions for vaso-occlusive crises. The periorbital swelling spread to the orbit in 4 cases and resulted in proptosis (2 cases), restriction of ocular motility and visual impairment. In all 4 cases, computed tomography and/or magnetic resonance imaging of the orbits showed a mass adjacent to the orbital wall. In 2 cases the mass was identified as a haematoma. Orbital wall infarction was demonstrated in 3 cases by bone/bone marrow scintigraphy. Epidural haematomas were detected by computed tomography in one case. All patients received intravenous fluids, analgesics, broad spectrum antibiotics and steroids, as well as simple or exchange transfusion, and responded well to medical management. Conclusions. Infarction of orbital bones during vaso-occlusive crises in sickle cell disease presents acutely with a rapidly progressive periorbital swelling. Haematomas frequently complicate the condition and, along with the inflammatory swelling, may lead to orbital compression syndrome. The condition is therefore sight-threatening, and necessitates prompt diagnosis and appropriate management for resolution without adverse sequelae. Imaging techniques are invaluable in the evaluation of patients. The majority of cases resolve with conservative treatment that includes steps to combat the vaso-occlusive crisis and use of systemic steroids under antibiotic cover.

Original languageEnglish
Pages (from-to)774-780
Number of pages7
JournalEye
Volume15
Issue number6
Publication statusPublished - 2001

Keywords

  • Management
  • Orbital compression syndrome
  • Orbital haemorrhage
  • orbital infarction
  • Sickle cell disease

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems

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    Ganesh, A., William, R. R., Mitra, S., Yanamadala, S., Hussein, S. S., Al-Kindi, S., Zakariah, M., Al-Lamki, Z., & Knox-Macaulay, H. (2001). Orbital involvement in sickle cell disease: A report of five cases and review literature. Eye, 15(6), 774-780.